1013940667 NPI number — DR. RAMSEY TANAKATSUBO OD

Table of content: DR. RAMSEY TANAKATSUBO OD (NPI 1013940667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013940667 NPI number — DR. RAMSEY TANAKATSUBO OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANAKATSUBO
Provider First Name:
RAMSEY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013940667
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7011 W NORTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-848-3900
Provider Business Mailing Address Fax Number:
708-848-3997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7011 W NORTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-848-3900
Provider Business Practice Location Address Fax Number:
708-848-3997
Provider Enumeration Date:
07/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0001616047 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: DC5096 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".